Table Of ContentCOUNSELING FOR DRUG ADDICTION
Individual, Family & Group
A Field Guide for Trainers
Concepts
Issues
Practical Tools and Resources
DR. SHANTHI RANGANATHAN
Honorary Secretary
RUKMANI JAYARAMAN
Honorary Consultant
V. THIRUMAGAL
Director – Quality Assurance and Patient Care
T T RANGANATHAN CLINICAL RESEARCH FOUNDATION
IV MAIN ROAD, INDIRA NAGAR, CHENNAI-600 020
1
INTRODUCTION
Dear Trainer,
Training people in the field of addiction is a challenging task. As trainers,
we are expected to expand their knowledge base, sharpen their clinical skills
and generate enthusiasm to work in and contribute to this field.
This manual will help you understand and effectively manage this task.
Certain standardization is maintained with regard to the terminology used in
this manual. The patient is referred to as a male, and the family member is
represented by the wife / mother and therefore referred to as a female. The
counselor is presented as a female professional. This however, does not
imply that all drug abusers are male or that all counselors are female. This
has been maintained only as a matter of convenience.
The manual has eight chapters. Each chapter includes three parts.
1. Information section, where facts are presented in a format which
is easy to read and follow
2. Skills sharpening tools, wherein problems and issues likely to be
raised by trainees are discussed. Additional focused information
and implementation tools find a place here.
3. Internalizing tools cover case studies to help trainees internalize
the concepts and practices.
This manual is the outcome of the painstaking efforts of a team of
professionals with over 20 years of experience in the field of addiction
prevention, treatment and research in India.
We hope you will like this manual, and use it to transform each of
your trainees into well-equipped, confident and skillful professionals.
Please write to us to let us know where we could improve. We remain
as always your partners in the task of prevention and treatment of
addiction.
2
Yours truly,
SHANTHI RANGANATHAN
RUKMANI JAYARAMAN
THIRUMAGAL
CONTENTS
INTRODUCTION
1 BASIC COUNSELING TECHNIQUES
2 THE PROCESS OF ADDICTION COUNSELING
3 SPECIAL ISSUES IN ADDICTION COUNSELING
4 ADDICTION – Its Impact on the Family
5. FAMILY IN RECOVERY
3
6 HELPING PARENTS – Adopt Protective Roles
7 GROUP THERAPY TECHNIQUES
8 ISSUES IN GROUP THERAPY
4
1
BASIC COUNSELING TECHNIQUES
Counseling is used to help individuals to deal with variety of problem
situations. During counseling, the counselor establishes a warm, supportive,
therapeutic relationship with the client using a variety of skills. Based on
the strength of this relationship, the counselor helps the client explore
problem areas, set goals and assists the client to work through problems in
order to establish a more meaningful and productive life style. During
addiction treatment, individual counseling aims at enabling the client to
learn how to identify and pursue realistic and satisfying solutions to his
problems, particularly those related to his chemical abuse. In order to make
individual counseling effective, the counselor has to understand the client as
an individual – the influences which have affected him, his perception of
himself and others around him – so that she can help the client realize how
those forces have led to unhealthy ways of coping both prior to and after
the onset of addiction.. This understanding at the level of feelings rather than
at the intellectual level (or the objective level), will enable him to cope with
life more satisfactorily. The purpose is to help the client in making decisions
about his life and enable him to understand the need to take responsibility
for his actions as well as their consequences.
QUALIFICATIONS OF THE COUNSELOR
The qualification required for a counselor is a post-graduation in Social
Work or Psychology with training in counseling. However, in the field of
addiction, recovering addicts by virtue of their own experience at recovery
can work as counselors after adequate training. He should have however
maintained atleast 3 years of sobriety during which he has made
qualitative changes in his life. He must also be emotionally stable and
should have dealt with his personality defects like impulsiveness,
irresponsibility, aggressiveness, selfishness and indiscipline.
5
QUALITIES NECESSARY FOR A COUNSELOR
(cid:190) Ability to listen – Listening is much more than merely hearing words. It
involves intuitive perception, watching for cues other than those
conveyed through words (tone of voice, gesture, posture) and
understanding the messages that the client is trying to convey, over-
emphasize or avoid.
(cid:190) Empathy – An ability to sense the client’s private world ‘as if’ it were the
counselor’s own, but without losing the ‘as if’ quality, is important.
Empathy does not imply agreeing to the client’s view of things; she
understands and is able to grasp his feelings and thoughts.
(cid:190) Non-judgmental attitude – Being open to the other person’s point of view
is a great asset. The counselor neither agrees nor disagrees; she
understands. Such an unbiased involvement is essential to adopt a
constructive approach to the client’s problem. The counselor should not
have a ‘holier-than-thou’ attitude, nor communicate in any way that she
is above the client.
(cid:190) Genuineness – The counselor is sincerely interested in the care and
well-being of the client and does not have to put on an act to convince
him of that. She is able to be herself and can truly reflect her thoughts
and feelings without discrepancy between what is felt and what is said.
She does not give the impression of being all knowing or give false
assurance just to impress the client. This however, does not mean that
she is brutally honest to the point of hurting the client.
(cid:190) Emotional maturity – The counselor should have the maturity to set
personal and professional boundaries.
(cid:190) Patience and flexibility – The counselor should be able to adapt her role
and pace according to the client’s needs and capacities. Rigidity in roles
and approaches may provide comfort for the counselor, but often does
little for the client. The counselor should be a sympathetic friend, a
leader, a negotiator or an educator and be able to move between these
multiple roles.
6
BASIC PRINCIPLES OF COUNSELING
Respect for the client
The skill of a counselor lies in communicating a sense of self-respect to the
client. The client needs to accept the belief that every person possesses the
inherent strength and capacity to ‘make it’ in life, and that each person has
the right to choose his own alternatives and make his own decisions. It is
also important that respect for the client should be reflected in the manner
the counselor conducts herself. She should always be professional; for
instance she should not be late for appointments and should never talk to or
treat the patient in a derogatory or disrespectful manner.
Being a Role Model
The counselor should set an example to the client through her personal
behavior and attitude.
Confidentiality
Maintaining confidentiality is very important in a counseling relationship as
this leads to the development of trust. The counselor should not reveal the
client’s identity, personal details and such information to other people
without the client’s permission. In addition, she must assure the client that
confidentiality will be maintained to gain his trust.
To be in Command
Once an assessment is made and counseling has begun, the counselor should
be able to guide the client away from trivialities or irrelevancies. The
counselor who allows herself to be manipulated without knowing it will not
be able to command the client’s respect.
Emphasizing the Client’s Personal Responsibility for Recovery
7
The counselor should be able to guide the client in the early stages of
recovery and make him understand that the recovery process ultimately
rests with the client.
Providing Direction and Encouraging Self-Direction
The counselor must strike a balance between providing direction and
allowing the client to be self-directed. It is essential that the counselor create
a structure in the session that includes giving the client feedback on his
progress in recovery. She identifies the relevant topics for discussion, based
on what the client seems to need, and introduces those topics. At times the
counselor may direct the patient to change certain behavior, for example, to
start attending self-help meetings.
However, the patient should also be encouraged to be self-directed. For
example, within the framework of a particular topic, perhaps coping with
‘social pressure to use’, the patient may explore how to manage this problem
best, and the counselor will respond to the patient’s ideas. If the patient
seems unable to change some aspect of addictive behavior, the counselor
should accept the situation and assist him to explore those perceptions or
situations in a way that might allow him to deal with them differently. A
balance needs to be maintained so that there is respect for the patient,
acceptance of where he is, and still provide motivation for abstinence and
recovery.
Conscious of Her Own Issues
The counselor needs to be aware of the possibility of her own issues being
triggered by a patient’s problems; she must consciously refrain from basing
her response in the context of her own personal issues. For example, a
counselor in recovery may feel that it is personally important for her to break
ties with addicted peers to maintain sobriety. If this counselor happens to
work with a patient who has an addicted sister with whom the patient has a
valuable relationship, it is important that the counselor be flexible and
respond creatively to the patient’s own perception of the problem.
8
THERAPEUTIC COMMUNICATION SKILLS USED IN
COUNSELING
The outcome of a meeting between the counselor and the client will depend
a great deal on how comfortable the client feels with the counselor, so that
he may entrust his genuine feelings to her, including information which he
may feel is very private and personal and which he is reluctant to share. This
can be achieved by the use of certain communication skills that create an
atmosphere of support for the client and the process.
The process of communication between the client and the counselor in the
counseling situation is a continuous two-way sequence. This sequence of
events ensures that the counselor listens (receives the message); processes
(considers the message in combination with previous knowledge and
experience); and responds (delivers a response to the original message).
LISTENING
Attending
Paraphrasing
Reflection of feelings
Self-disclosure
Summarizing
Silence
↓
PROCESSING
↓
RESPONDING
Probing
Interpreting
Confronting
Silence
9
LISTENING
Attending
This refers to a concern by the counselor with all aspects of the client’s
communication. It includes listening to the verbal content, observing non-
verbal cues and then communicating back to the client that she is paying
attention. The skill of attending is the foundation on which all other skills
are built.
Guidelines for effective attending:
- communicate listening through eye contact and facial expression
- maintain a relaxed physical posture and lean forward occasionally, using
natural hand and arm movements
- verbally ‘follow’ the client, using a variety of brief encouragements such
as ‘um-hm’, ‘yes’, or repeating key words.
Attending helps the client to
- relax and feel comfortable
- express his ideas and feelings freely in his own way
- trust the counselor
- feel more responsible for what happens in the session by enabling him to
direct the session.
Attending enables the counselor to
- obtain accurate inferences about the client through careful observation.
The client may ask the counselor about the availability of medical help to
deal with the withdrawal symptoms. The counselor may notice that he
sits on the chair wringing his hands and looking very anxious. Even if
the client does not say so verbally, the counselor recognizes the need for
reassurance. So, instead of responding with a general statement that
medications will be provided, the counselor needs to help him express
his fears and answer specific questions that he may have.
Paraphrasing
10
Description:Honorary Consultant. V. THIRUMAGAL. Director – Quality Assurance and Patient Care. T T RANGANATHAN CLINICAL RESEARCH FOUNDATION.
